Optimal Self-Management Anticoagulation Therapy vs. Ross Procedure

[DachsieMom]

By the way, I met a man yesterday with my same valve (st Jude aortic valve and conduit graft). 26 years for him and going strong!

 

[pellicle]

Hi

Thank you all!!
for some reason I can’t upload the picture of the chart I refer to. It seems I don’t have permission to upload pictures yet.

ahh, thats for paid users. I reference images by their url and put that between img tags. A tag is a special word (like img) between square braces [ and ] surrounding the URL ... look up bbcode, its quite like HTML

However I don't see that percentage given in that chart.

[IMG2=JSON]{"data-align":"none","data-size":"full","src":"https:\/\/c2.staticflickr.com\/4\/3868\/14626794599_c646b1872d_b.jpg"}[/IMG2]


The above chart is NOT age correlated ... it is just the cohort as reported in that study:

Which was: "Optimal level of oral anticoagulant therapy for the prevention of arterial thrombosis in patients with mechanical heart valve prostheses, atrial fibrillation, or myocardial infarction: a prospective study of 4202 patients."

http://jamanetwork.com/journals/jama...article/415179

Let’s say that this careful behavior results in being 80-90% of the time within a INR range of 2-3. I assume that this situation still has some risk which I’d like to understand to estimate the long term probability of being event free. Does this make sense?

It does, the best i can answer that is with the observation from the studies which suggest you will be at the normal risk for normal people of your age group.

From the GELIA study:

Conclusions: The intention-to-treat analysis of the results of the German Experience With LowIntensity Anticoagulation study leads to the unexpected result that despite a sophisticated reporting system, the incidence of moderate and severe TE and bleeding complications was comparably low in all INR strata and more or less within the so-called background incidence reported for an age-related “normal” population.

 

[Agian]

Hi everybody, new in this forum. Need an AVR and Aoric root replacement. I am almost sure that I will go for the mechanical option but I am struggling with facts that shows that anticoagulated patients who manage to keep their INR within the safe zone still have a 1-2% annual risk of bleeding/having a stroke. I am 42 and this figure is a bit scary as the probability of being event free in the next 30-40 years is not that high. Is this reasoning correct? Thank you very much! Finding this very interesting. Can’t stop reading!

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1-2% is not surprising, given that most people test monthly.

 

[Seaton]

Hi everybody, new in this forum. Need an AVR and Aoric root replacement. I am almost sure that I will go for the mechanical option but I am struggling with facts that shows that anticoagulated patients who manage to keep their INR within the safe zone still have a 1-2% annual risk of bleeding/having a stroke. I am 42 and this figure is a bit scary as the probability of being event free in the next 30-40 years is not that high. Is this reasoning correct? Thank you very much! Finding this very interesting. Can’t stop reading!

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Hi Perico ...

Here's an active farmer who has been doing very well with his mechanical valve for over 25 years (probably 26 now?).

I wish you the very best whatever path you choose.

 

[perico75]

Hi, thanks again!

By the way, I met a man yesterday with my same valve (st Jude aortic valve and conduit graft). 26 years for him and going strong!

Good to know about this success stories to keep spirit high in light of upcoming surgery!

 

[perico75]

Hello Pellicle, thank you very much!!

Hi

It does, the best i can answer that is with the observation from the studies which suggest you will be at the normal risk for normal people of your age group.

This is very good news!

 

[perico75]

Having already chosen to go for the mechanical option for the Aortic Valve Graft Replacement I am basically looking at two alternatives:
1 - St Jude
2 - On-X
I read about the possibility that the On-X can tolerate lower levels of INR so my first reaction is to go for the On-X. Just wondering why St Jude did not adopt the same material as On-X considering that the ON-X got approval for lower INR?
My surgeon is OK with any of the two although he said that he does more of St Jude. He also mentioned that the effective area of the St Jude is a bit higher for same external diameters when compared to the On-X as the St Jude frame is a bit smaller.
Any thoughts about this?

 

[Superman]

On-X received approval because they pursued approval. As to what it means? Did you ever watch the movie, "This is Spinal Tap."?

"But these amplifiers go to eleven".

Okay, I concede, it's not as simple as that, but to me, outside of bleeding risk - are there other health issues with warfarin? Does it damage the liver? Kidneys? G.I. tract? Any other reasons why lower = better? Or is it marketing because lower seems more appealing?

I really don't know. Myself, I've been dosing with a target of 2.5 - 3.5 for nearly 27 years without incident. I'm perfectly comfortable going with what I know. I've had a couple recent draws at or around 2.0 and don't feel any different other than anxious to get back to the range I know and love. Personally, I'm more afraid of clots than bleeds, so lower would not help me sleep at night.

 

[perico75]

Hi superman!

On-X received approval because they pursued approval. As to what it means? Did you ever watch the movie, "This is Spinal Tap."?

"But these amplifiers go to eleven".

Okay, I concede, it's not as simple as that, but to me, outside of bleeding risk - are there other health issues with warfarin? Does it damage the liver? Kidneys? G.I. tract? Any other reasons why lower = better? Or is it marketing because lower seems more appealing?

I really don't know. Myself, I've been dosing with a target of 2.5 - 3.5 for nearly 27 years without incident. I'm perfectly comfortable going with what I know. I've had a couple recent draws at or around 2.0 and don't feel any different other than anxious to get back to the range I know and love. Personally, I'm more afraid of clots than bleeds, so lower would not help me sleep at night.

Ha ha ha! Well, maybe one would not change the INR target but it is always good to know that if your INR happens to be below 2 (1.5-1.8) you are still at low risk of producing a clot.
Thank you!

 

[dick0236]

Okay, I concede, it's not as simple as that, but to me, outside of bleeding risk - are there other health issues with warfarin? Does it damage the liver? Kidneys? G.I. tract? Any other reasons why lower = better? Or is it marketing because lower seems more appealing?

............ Personally, I'm more afraid of clots than bleeds, so lower would not help me sleep at night.

I agree with Superman and would wonder more about any long term effects of using warfarin for the "long haul". I keep waiting for long term side effects to occur and, as far as I know, none have......and I have been on the stuff for 50+years and am more comfortable at the higher end of my range. I've never had a uncontrolled "bleed" but I've had a clot.....and stroke, due to low INR.

Warfarin has gotten a bad reputation due to the majority of patients have been elderly and prone to misusing the drug. If you are in the USA, I'm sure you've seen the cable tv ads regarding class action lawsuits against the manufacturers of the newer class of blood thinners. These newer drugs are touted to require no testing or life style adjustments....but the patient still has to take the "blood thinner" correctly......and apparently the patients are misusing these newer drugs, just like they misused warfarin. To me, correct warfarin management is as simple as "take the pill as prescribed and test routinely"

 

[pellicle]

Warfarin has gotten a bad reputation due to the majority of patients have been elderly and prone to misusing the drug.

I'm not sure we can absolve the clinics from culpability here...

 

[pellicle]

maybe one would not change the INR target but it is always good to know that if your INR happens to be below 2 (1.5-1.8) you are still at low risk of producing a clot.

Exactly the best view IMO